Updated: 2/19/2023

Adult Knee Radiographic Views

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  • NORMAL ANATOMY
    • Osteology
      • Distal femur
        • anterior/posterior view
        • lateral view
      • Proximal tibia
        • anterior/posterior view
      • Patella
        • anterior/posterior view
    • Attachments
      • Muscle
        • anterior view
        • posterior view
        • lateral view
      • Ligament/tendon
        • anterior/posterior view
  • AP/PA view
    • Positioning
      • patient
        • supine (AP) vs. prone (PA)
        • knee extended + leg IR 3-5°
      • beam
        • aim 1.5cm distal to apex of patella
    • Indications
      • fracture
      • joint alignment
      • OA
        • PA view preferred over AP view
        • weightbearing view preferred over non-weightbearing view
    • Critique
      • symmetrical femoral + tibial condyles
      • fibular head should be bisected by the tibia
      • visualization of intercondylar eminence in intercondylar fossa
  • Lateral view
    • Positioning
      • patient
        • rolled lateral (mediolateral) = lateral decubitus on ipsilateral side + knee flexed 20-30°
        • horizontal ray (lateromedial) = supine + knee extended
      • beam
        • aim 2.5cm distal to medial epicondyle
        • tilt 5-7° cephalad (if rolled lateral)
    • Indications
      • patella fracture = horizontal ray view to avoid displacement
      • patella alta/baja = requires knee in 30° flexion
      • trochlear dysplasia
      • OA
      • joint effusion
    • Critique
      • visualization of suprapatellar fat pad = via knee flexion < 30°
      • appropriate IR/ER
        • superimposition of posterior aspect of femoral condyles
        • superimposition of fibular head + tibia
        • open patellofemoral joint
        • no visualization of adductor tubercle
      • appropriate cephalad angulation = open tibiofemoral joint
  • Oblique view
    • Positioning
      • patient
        • AP = supine + knee extended + leg IR/ER 45°
        • PA = prone + knee flexed 10° + leg IR/ER 45°
      • beam
        • aim 1.5cm distal to apex of patella
    • Indications
      • fracture = femoral condyle, patella
      • OA
      • intercondylar fossa pathology = loose bodies
    • Critique
      • superimposition of patella + ipsilateral femoral condyle
      • asymmetrical tibiofemoral joint spaces
  • Intercondylar view
    • Positioning
    • METHOD
      PATIENT
      BEAM
      Becleresupineknee flexed 40°AP40° cephalad
      Camp Coventry/Tunnel
      proneknee flexed 40°PA40° caudad
      Holmbladerectvs. kneelingknee flexed 70°PA
    • Indications
      • OCD = displaced cartilage
      • congenital slipped patella = flattening/underdevelopment of lateral femoral condyle
      • hemophilia = intercondylar widening
      • intercondylar fossa pathology = loose bodies
    • Critique
      • superimposition of patella + ipsilateral femoral condyle
      • asymmetrical tibiofemoral joint spaces
  • Tangential view
    • Positioning
    • METHOD
      PATIENT
      BEAM
      Sunrise/Settegastsupinevs. proneknee flexed 90°inf-sup
      10-20° cephalad
      Hughston
      proneknee flexed 50-60°inf-sup45° cephalad
      Merchantsupineknee flexed 40°sup-inf30° caudad
      Laurine
      semi-recumbentknee flexed 30°inf-sup30° cephalad
    • Indications
      • patellar malalignment
      • trochlear groove depth
      • OA
      • vertical patella fracture
    • Critique
      • visualization of femoral condyles + trochlear groove
      • no superimposition of patella + femur
      • open patellofemoral joint
  • NORMAL FINDINGS
    • Normal anatomy anatomy chart
    • Normal variants
      • fabella
        • sesamoid bone in lateral head of gastrocnemius
        • best seen on lateral view
      • cyamella
        • sesamoid bone in popliteus tendon
        • usually present in lateral aspect of distal femur in popliteal groove
        • best seen on AP view
      • cortical desmoid
        • cortical lucency in posteromedial aspect of distal femur
        • represents origin of medial head of gastrocnemius + insertion of adductor magnus
        • seen in adolescents (10-15 yo)
      • bipartite/tripartite patella
        • usually superolateral with smooth margins
      • double-layered patella
        • rare form of bipartite patella
        • multiple fragmented patella with smooth well-corticated borders
        • pathognomonic for multiple epiphyseal dysplasia

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